Research On Stent-assisted Coils In The Treatment Of Acute Intracranial Aneurysms

Objective: Endovascular treatment is the first choice for the treatment of intracranial aneurysms.Stent assisted technique has certain advantages in the treatment of wide neck or dissected aneurysms,which makes complex aneurysms easy to embolize,and the coil is not easy to break into the artery carrying the aneurysm,so as to maintain the blood supply of the artery carrying the aneurysm,increase the success rate of the operation and reduce the recurrence rate after the operation.However,the treatment of acute ruptured aneurysms is still controversial,with a high complication rate.The advantages of stent application are obvious.In view of this,we reviewed and analyzed the clinical data of stent assisted coil and other different interventional methods in the treatment of acute intracranial aneurysm,to explore the safety,effectiveness and prognosis of stent assisted coil in the treatment of acute intracranial aneurysms,and to explore the relevant factors affecting the prognosis.To provide reference for clinical doctors in the treatment of acute intracranial aneurysm with stent assisted coil.Methods:The clinical data of 180 patients with acute intracranial aneurysm treated by endovascular embolization were analyzed retrospectively from August 1,2016 to August 31,2018 in neurosurgery department of Yijishan hospital,Wannan Medical College.The general data of the patients were collected and sorted out(including patients’ name,gender,age of onset,whether there was hypertension,preoperative H-H classification,combined with CT imaging data Improved CT Fisher).Preoperative evaluation of patients’ condition,time of interventional operation,operation mode,degree of embolization,surgical complications,treatment effect,postoperative recovery,modified Rankin scale,GCS score and follow-up data(oneyearfollow-up,mRS prognosis score and recurrence)were collected.The clinical data were analyzed by spss20.0 statistical software to evaluate the stent assisted coil in the acute stage The safety and effectiveness of the treatment of intracranial aneurysms,single factor and multi factor Logistic regression analysis affect the treatment effect,prognosis and risk factors of recurrence of aneurysms,P < 0.05 was considered significant difference,with statistical significance.Results: A total of 180 patients with ruptured intracranial aneurysms were included,including 112 males and 68 females,with a male to female ratio of 1.65:1;the age ranged from 26 to 82 years,with an average age of(52.6 ± 12.8)years;the last preoperative cranial CT combined with improved CT Fisher classification: 14 cases in grade 1;110 cases in grade 3,36 cases in grade 4,20 cases in grade 4.Preoperative GCS score:15 : 116 cases,13-14: 32 cases.8-12:20 cases.3-7: 12 cases.H-H classification: 168 cases of grade I-III,12 cases of grade iv-v.According to the blood vessels involved in aneurysms,it can be divided into: posterior communicating artery aneurysm: 60;anterior communicating artery aneurysm: 41;ophthalmic artery segment aneurysm: 27;middle cerebral artery aneurysm: 12;vertebral artery aneurysm: 9;anterior cerebral artery A1 segment and basilar artery aneurysm: 8 each;anterior choroidal artery aneurysm: 6 each;posterior cerebral artery and posterior inferior cerebellar artery aneurysm: 4 each;corpus Marginal aneurysm: 1.Wide neck and narrow neck aneurysms were 142 and 38,respectively.After operation,there were 100 cases in sac group,86 cases in dense embolism,6 cases in residual tumor neck,8 cases in partial embolism,80 cases in CA Group,60 cases in dense embolism,14 cases in residual tumor neck,6 cases in partial embolism,the rate of dense embolism in sac group was higher than that in CA Group.The effect of sac is better than that of CA Group(P = 0.002),During the operation,9 cases were complicated with aneurysm rupture,2 cases in sac group,7 cases in CA Group,and 1 case in CA group died of rupture;in sac group,1 case was ruptured during anesthesia,and was immediately embolized with spring coil.At the end of the operation,the leakage of contrast agent was seen,protamine and heparin were given immediately,and then the aneurysm was quickly filled.After the operation,CT scan of the skull showed no hematoma formation,which did not affect the prognosis.The incidence of aneurysm rupture in sac group was lower than that in CA Group.There were 19 cases of intraoperative ischemic complications in the two groups,10 in sac group and 9 in CA Group.There was no difference in the risk of intraoperative ischemic complications between the two groups(P=0.78).The incidence of intraoperative spring coil,displacement,prolapse and untwist was 0 in sac group,4 in CA Group(χ2 = 5.04,P = 0.024).The difference was statistically significant.The incidence of cerebral vasospasm was 2 cases in sac group and 8 cases in CA Group.Multiple logistic regression analysis showed that age,gender,preoperative H-H score,GCS score,aneurysm site,aneurysm size,degree of embolization,stent type,and modified CT Fisher score were used as variables to analyze.The results showed that age,gender,preoperative H-H grade,admission GCS score,aneurysm site,aneurysm size,degree of embolization,stent type,and modified CT Fisher’s score was not an independent risk factor for intraoperative ischemic and bleeding complications(P > 0.05).By analyzing the prognosis of sac patients,the factors influencing the prognosis were included in the study,including preoperative H-H grade,admission GCS score,aneurysm size,degree of embolization,and CT Fisher score.The results showed that preoperative H-H grade and admission GCS score affected the prognosis risk factors.-Logistic regression analysis showed that preoperative H-H grade IV-V and admission GCS score≤7 were risk factors for prognosis of patients after sac treatment.Conclusion: Stent assisted coil embolization is safe and effective in the treatment of acute ruptured aneurysm.The patients with better H-H grade were better than those with poor grade.The lower the score of GCS,the worse the prognosis.For ruptured aneurysms,endovascular embolization should be performed as early as possible.Stent assisted coil embolization is easy to complicate thrombosis.Anticoagulant therapy should be strengthened before operation to improve the prognosis of patients.Stent assisted coil embolization can significantly reduce the recurrence rate of wide necked aneurysms.